Computed tomographic evaluation of multiple mucocoeles of paranasal sinuses

There are some cases in which mucocoeles of the paranasal sinuses are multiple and their structures are complicated. When the mucocoeles are multiple, pre-operative evaluation is especially important for correct surgical management. We describe the usefulness of computed tomography for the evaluation of multiple mucocoeles of the paranasal sinuses.     

Surgery for paranasal sinus mucocoeles: efficacy of endonasal micro-endoscopic management and long-term results of 185 patients

This study evaluates the most extensive long-term treatment outcome of paranasal sinus mucocoeles with particular emphasis on the efficacy of endonasal micro-endoscopic management. It is a retrospective, consecutive case review of 255 patients with 290 mucocoeles including 125 frontal sinus, 23 frontoethmoid, 41 ethmoid, 72 maxillary sinus and 26 sphenoid mucocoeles. The median follow-up of the patients is 12 years (range 1 - 19 years). Sixtysix percent of the mucocoeles resulted after previous sinus surgery, whereas only 1.5% developed after endonasal micro-endoscopic surgery. The median period until mucocoele appearence was 10.8 years. Two hundred one mucocoeles (69.3%) were managed endonasally micro-endoscopically, 18.6% via the osteoplastic approach, 10% endoscopically in combination with an osteoplastic procedure, and 2% according to Lynch/Howarth. Thereafter, recurrence was found in 4 patients only (2.2%). In relation to the endonasal approach the recurrence rate was 1.6%. None of the patients treated endonasally had any complication. In view of these results this paper verifies endonasal micro-endoscopic surgery as a reliable treatment with favourable long-term outcome for paranasal sinus mucocoele management, but also describes contraindications for an endonasal procedure.     

Combined approach (endoscopic and external) for the treatment of sinusal mucoceles

AIM OF THE STUDY: Determination of the best surgical approach in the treatment of mucocoeles of the sinuses according to their localization. PATIENTS AND METHODS: A retrospective study has been carried out including forty three cases of sinus mucocoeles, surgically treated from 1990 to 1997. These were in descending order, frontal (n = 19), maxillary (n = 10), ethmo?do-frontal (n = 9), sphenoidal (n = 3) and ethmoidal (n = 2). Surgical treatment was achieved with an exclusive endoscopic approach in 28 cases whereas 15 of them underwent endoscopic surgery associated with an external approach (also called combined technique). Short term complications and recurrence were recorded after a minimum of 6 years follow-up, according to the type of surgery performed and the topography of the mucocoele. RESULTS: Recurrence of mucocoeles is prevented in 95.8% of cases by an exclusive endoscopic treatment in ethmo?do-frontal, maxillary, sphenoidal and ethmoidal sites. On the other hand, the recurrence rate in mucocoeles involving the frontal sinuses without ethmoidal involvement, was significantly higher when the mucocoele was operated on by an exclusively endoscopic method (25%, p < 0.001) rather than by a combined technique (0%). DISCUSSION AND CONCLUSION: Ethmoido-frontal, maxillary, sphenoidal and ethmoidal mucocoeles are excellent indications for an exclusively endoscopic endonasal surgery. An external approach, combined with endoscopic surgery, is suitable in frontal mucocoeles, especially in distal sites and in case of recurrence.     

Mucocoeles of the maxillary antrum. Description, case reports and review of the literature

Mucocoeles of the maxillary antrum extensive enough to cause local bone destruction appear to be extremely rare. Such a case is reported with the appropriate pathological and radiological findings. Perusal of the literature suggests that this condition, unlike mucocoeles arising in other sinuses, may closely mimic a carcinoma and all authors stress the necessity for Caldwell-Luc surgery to be certain of the diagnosis. Som and Shugar (1980) describe features visible on CT scanning which may help to differentiate between mucocoeles, pyocoeles and carcinomata. In spite of the relatively high incidence of cysts of the antrum, it is thought unlikely that mucocoeles in this location would arise from such a cyst; indeed it is likely that all mucocoeles arise from blockage of the outflow tract of the appropriate sinus. There is a high incidence of maxillary sinus mucocoele in Japan following Caldwell-Luc surgery (Hasegawa et al., 1979). Noyek and Zizmor (1976) suggest that compartmentalization of the antrum after operation may leave islands of mucosa without drainage; such a collection may give rise to a mucocoele.     

Studies on mucocoeles of the ethmoid and sphenoid sinuses: analysis of 47 cases.

Forty-seven mucocoeles of the ethmoid and/or sphenoid sinuses (33 males, 14 females) were operated on during the 10-years period from 1980 through 1989. Thirty-seven cases were post-operative mucocoele, while the remaining 10 were so-called primary mucocoeles. None of the cases had a history of facial trauma. In the majority of post-operative cases, the mucocoele develops 15-24 years after initial surgery. Paranasal sinus surgery in young patients (teenagers) may lead to a mucocoele due to post-operative scarring in the surgical wound. The principal symptoms include globe displacement, double vision, headache, deep orbital pain, a mass in the supero-medial quadrant of the orbit, visual disturbance, etc. Sufficient opening of the mucocoele wall by the endonasal approach is recommended for surgical treatment of ethmoidal and sphenoidal mucocoeles.     

Giant mucocoele of the maxillary antrum: a case report

Maxillary antral mucocoeles have an incidence of only 3-10%. Mucocoeles are more commonly seen in the frontoethmoidal region. We present one such rare case of a 52-year-old lady who came to us with complaints of pain and swelling of the left cheek of 4?months duration. Clinical examination and investigation revealed a giant maxillary sinus mucocoele which was duly treated surgically. We discuss its classical presentation and management since such large mucocoeles are not often seen in the maxillary sinus.     

The place of endoscopic sinus surgery in the treatment of paranasal sinus mucocoeles

Mucocoeles of the paranasal sinuses often enlarge slowly resulting in local bone erosion with subsequent extension into the adjacent orbit or intracranial space. We have reviewed the management of 59 patients with 68 mucocoeles. The variety of presentations is examined and discussed. Although diplopia has previously been stated as a very common finding we have found this not to be the case and believe that it may be that previous reports originate from ophthalmology centres. Forty-four patients underwent endoscopic surgical management of their mucocoeles, nine had a combined external and endoscopic procedure and 14 patients had an external approach. One patient needed no surgery. The mean follow-up period was 6 years 3 months. There was the lowest number of recurrences in the endoscopic surgical group. We emphasize the importance of long-term follow-up.     

A survey of contemporary management of frontal sinus disease in the United Kingdom

Surgery for frontal sinus disease historically has required an external approach. With the advent of endoscopic sinus surgery, endoscopic treatment for various frontal sinus pathologies has been described. This survey examined how widespread the use of endoscopy in frontal surgery has become. We were interested both in the acute emergency situation and in the more chronic situations such as mucocoeles. The replies of 266 practising United Kingdom surgeons to a postal questionnaire were evaluated. While 45% of surgeons regularly practise functional endoscopic sinus surgery (FESS), approximately 25% would attempt endoscopic drainage of acute frontal sinusitis and most perform an external trephine. Most surgeons also rely on external approaches to manage mucocoeles or pyocoeles (54%), although some (39%) attempt endoscopic drainage if the cyst lies sufficiently medially. Even with recurrent or intractable disease one-third attempt endoscopic surgery. When external surgery is used in the United Kingdom, only a small number of surgeons favour obliteration. Received: 20 July 1999 / Accepted: 22 July 1999     

Visual dysfunction: abnormal sign of benign sphenoethmoidal lesions

Isolated visual dysfunction with or without proptosis is rarely described as a sign of benign sphenoethmoidal lesions. Five patients with benign swelling of the sino-orbital region and related visual defects are reported. Cases include one patient with fibrous dysplasia, two patients with mucocoeles and two patients suffering from aspergillosis of the sinuses. A review of the literature and discussion of the cases is presented.     

Postoperative mucocoeles of the maxillary sinuses (author's transl)

The postoperative occurrences of mucocoeles of the maxillary sinuses are much rarer than those of the frontal or ethmoid sinuses. Their occurrence following Caldwell-Luc operations is 1:150. They may originate from obliteration of the sinus ostia (antritis dilatans) as well as from residuel mucosa in the upper lateral recesses of the sinus cavities. There are four clinical types of mucocoeles: (1) those which present with a swelling of the cheek, (2) those with destruction of the orbital floor with elevation of the eye, (3) those with destruction of the hard palate (which are extremely rare), and (4) those which present as multiple cysts (also rare). Among the author's 20 cases, there were 15 of the first group, 4 of the second and one of the fourth. In differential diagnosis, ameloblastoma of the maxilla must be considered. When suppuration (or pyocoele) occurs, the clinical picture may be similar to that of periorbital edema or inflammation. Operative treatment requires complete removal of the mucocoele and restoration of nasal drainage. When destruction of the orbital floor has occurred, reconstruction with a free septal cartilage graft is recommended.     

Nasopharyngeal glioma: A unique presentation in infants

Despite the complex embryological development of the nose and surrounding structures, significant developmental nasal anomalies are rare. Of the various anomalies like-nasopharyngeal cysts, hairy polyps, dermoids, haemangiomata, fibromas, mucocoeles, lipoma, aplasias. We are presenting a rare case of Heterotopic Brain Tissue in the nasopharynx. This 1.5-month-old patient was operated through transpalatal route and mass excised. Histopathologicaly it consisted of various central nervous tissue elements. Seven months post surgery patient is thriving well.     

Ethmoidal mucocoeles in children

Children presenting with ethmoidal mucocoeles are rare. Five children are presented with such findings, and the diagnosis, treatment and possible aetiology discussed. C.T. scanning was found to be the investigation of choice, while plain sinus X-rays correlated poorly with the presence of disease. Exenteration through an external approach was found to be satisfactory. In two cases drainage obstruction due to congenital abnormality was thought to be the underlying cause, while in four cases there was a strong history of atopy, indicating allergy as a possible reason for mucocoele formation.     

Ophthalmic considerations in fronto-ethmoidal mucocoeles

The pre- and post-operative ophthalmic consequences of fronto-ethmoidal mucocoeles are considered in a prospective series of 22 patients. Proptosis, lateral and inferior displacement, diplopia and restriction of ocular mobility were the commonest presenting problems. Following external fronto-ethmoidectomy, proptosis and displacement resolved completely in the majority of patients. One third of patients experienced a transient exacerbation of diplopia but this resolved in most patients. Persistent diplopia occurred in seven patients and required medical correction in four and surgery in one. This was due in all cases to underaction of the superior oblique muscle and probably to backward displacement of the trochlea which may be avoided by careful surgical re-attachment.     

孤立性蝶窦占位性病变的诊断与治疗

进一步认识孤立性窦占位性病变,提高对其诊断和治疗水平。方法在鼻内窥镜下摘除蝶窦囊肿２０例,行蝶窦探查术６例,经鼻外径路摘除囊肿３例,前颅底径路病变切除＋视神经减压术１例。结果２４例随０．５－４年无复发,１例术后不久囊肿复发,１例术后１年复发再次手术后随访１年无复发,１例正在放疗中３例失访。     

Endoscopic sinus surgery

Endoscopic nasal surgery has become the single major advance in the specialty of otolaryngology since the introduction of the operating microscope and middle ear surgery. The value of improved assessment of nasal and sinus pathology using the endoscope diagnostically cannot be overstated. Once pathology is better evaluated, therapy will at least be more appropriate. It is now possible to carry out such nasal surgery as polypectomy, antrostomy and turbinoplasty more accurately and more safely, as well as provide better postoperative care. The use of the endoscope has afforded a useful sub-cranial route for the repair of at least small cerebrospinal fluid leaks, while it is likely that such procedures as dacrocystorhinostomy will eventually be mostly performed using the nasal endoscope. Some orbital decompressions will also be suitable for medial orbitotomy via the endoscope. Additionally, assessment of the extent of extrusion of orbital contents after blow-out injury has been invaluable, as is evaluation of the posterior wall of the frontal sinus after frontal bone trauma. Functional endoscopic sinus surgery (FESS) has an undoubted place in the surgery of frontoethmoidal mucocoeles. While few oncologists would be sanguine about its use in the surgery of nasal tumors, it is still of great value in evaluation and biopsy. Although FESS confined to the osteomeatal complex in the presence of early sinus disease is almost certainly an advance, what is still not proven, is the place of endoscopic sphenoethmoidectomy in the treatment of chronic rhinosinusitis.     

Neonatal respiratory distress secondary to bilateral intranasal dacryocystocoeles

Obstruction of the nasolacrimal duct is a common congenital abnormality reported in up to 84% of neonatal patients [J. Yohendran, A.C. Wignall, E.J. Beckenham, Bilateral congenital dacryocystocoeles with concurrent intranasal mucocoeles causing respiratory distress in a neonate, Asian J. Surg. 29 (2) (2006) 109-111; M.J. Cunningham, J.J. Woog, Endonasal endoscopic dacryocystorhinostomy in children, Arch. Otolaryngol. Head Neck Surg. 124 (1998) 328-333; D. Guery, E.L. Kendig, Congenital impotency of the nasolacrimal duct, Arch. Ophthalmol. 97 (1979) 1656-1658]. Rarely, obstruction results in the development of an intranasal lacrimal duct cyst, or dacryocystocoele, which arises inferolateral to the inferior turbinate [H.R. Jin, S.O. Shin, Endoscopic marsupialisation of bilateral lacrimal sac mucoceles with nasolacrimal duct cysts, Auris Nasus Larynx 26 (1999) 441-445]. These lesions can cause nasal obstruction and, when bilateral, significant respiratory compromise. We present the case of a 3-day-old infant with bilateral intranasal lacrimal duct cysts causing nasal obstruction and intermittent respiratory compromise. The diagnosis was suspected on clinical examination and confirmed on MRI. The patient was successfully managed by bilateral endoscopic marsupialisation and probing of the nasolacrimal ducts. We also present a review of the literature surrounding investigation and management of intranasal lacrimal duct cysts.     

Extramedullary hematopoiesis occurring as a nasal polyp in a man with a myeloproliferative disorder

We describe the case of a patient with a known myeloproliferative disorder who presented with epistaxis and what clinically appeared to be a nasal polyp. The mass was resected and proved to represent a focus of extramedullary hematopoiesis. The patient subsequently developed extramedullary hematopoiesis of the skin and the stomach wall. Following nasal polypectomy, he did well for a time, but he eventually died as a result of other complications of his disease. This unique case serves as a reminder that common rhinologic complaints can be a sign of significant and life-threatening pathology.     

Tonsillectomy as a routine treatment in cases of branchiogenic cancer

The pathogenesis of the branchiogenic cancer is still unknown. A number of authors think that it is a metastasis in the form of a cyst from a primary focus in the pharynx most often located in the palatal tonsil. Hence a conclusion is put forward to perform a tonsillectomy even when a tonsil is not clinically changed. The author presents a medical record of a patient with plano-epithelial carcinoma of a cyst from a primary focus in the pharynx most often located in the palatal tonsil. Hence a conclusion is put forward to perform a tonsillectomy even when a tonsil is not clinically changed. The author presents a medical record of a patient with plano-epithelial carcinoma of a lateral cervical cyst. It developed in the epithelium, sub-epithelium and in the palatal tonsil. The tonsillectomy was performed in spite of the clinically unchanged. This case indicates that cancer can develop simultaneously in the cyst wall and in the tonsil. The presence of the wall architecture elements typical of a lateral cervical cyst and the duct connecting the cyst with the wall of the pharynx indicates that it wasn't a metastasis from the focus in tha tonsil. The development of both these focuses could have resulted from the spreading of a lesion through continuity in the ascending way (a cyst-a tonsil) or through the descending way (a tonsil-a cyst). The author suggests that a branchiogenic cancer is an indication for a routine prophylactic ipsilateral tonsillectomy and neck dissection together with consecutive irradiation.     

An assessment of risk factors for the development of a second primary malignancy in the head and neck

This retrospective database study of 44,862 patients who had a history of a primary head and neck malignancy was conducted to identify any clinical variables that may predict the occurrence of a second primary head and neck malignancy. During a mean follow-up of 42.2 months, a second head and neck primary developed in 941 of these patients (2.1%). Statistical analyses revealed that a higher incidence of a second primary was associated with increased age and a location of the first primary in the larynx/hypopharynx, the oropharynx, a major salivary gland, or the nasopharynx. A lower incidence was associated with the presence of cervical nodal disease or treatment of the first primary with radiation therapy. Factors that had no effect on the risk of a second primary included sex, the size of the first primary tumor, a first-primary site in the oral cavity, and treatment of the first primary with cancer-directed surgery. The risk of a second primary head and neck cancer remained constant for at least 10 years.     

The relationship between tinnitus pitch and the audiogram

We studied the relationship between tinnitus pitch and the audiogram in 195 patients. Patients with tone-like tinnitus reported a higher pitch (mean = 5385 Hz) compared to those with a noise-like quality (mean = 3266 Hz). Those with a flat audiogram were more likely to report: a noise-like tinnitus, a unilateral tinnitus, and have a pitch < 2000 Hz. The average duration of bilateral tinnitus (12 years) was longer than that of unilateral tinnitus (5 years). Older subjects reported a less severe tinnitus handicap questionnaire score. Patients with a notched audiogram often reported a pitch ≤8000 Hz. Subjects with normal hearing up to 8000 Hz tended to have a pitch ≥8000 Hz. We failed to find a relationship between the pitch and the edge of a high frequency hearing loss. Some individuals did exhibit a pitch at the low frequency edge of a hearing loss, but we could find no similar characteristics among these subjects. It is possible that a relationship between pitch and audiogram is present only in certain subgroups.